New Hampshire Orthopaedic Center Welcomes Fellowship-Trained Trauma Surgeon

Posted on August 9, 2016.

New Hampshire Orthopaedic Center is pleased to welcome Bryan K. Houseman, D.O., a fellowship-trained trauma … Read More

New Hampshire Orthopaedic Center Selected ‘Best Orthopaedic Office’ by Union Leader Readers for Fourth Consecutive Year

Posted on July 21, 2016.

The readers of the New Hampshire Union Leader have selected New Hampshire Orthopaedic Center as … Read More

FREE Sports Physicals – 3/16/16

Posted on February 26, 2016.

Winter sports are winding down, but spring is just around the corner.  Parents and athletes … Read More

New Hampshire Orthopaedic Center

Knee Replacement in Congo – Part I

Posted on August 5, 2016.

by: Kathleen A Hogan, MD

The Democratic Republic of Congo

The Democratic Republic of Congo (DRC), formerly known as Zaire, is not a tourist destination.    Because of ongoing violence, much of the country is inaccessible.   There are warnings for travelers posted on the US Embassy website. There is an ongoing yellow fever epidemic.   The DRC is one of the largest countries in Africa and also one of the poorest.  The country has been devastated by multiple wars, corruption, and a dictatorship. So why would I travel there?    

Knee Replacements at Biamba Marie Mutombo Hospital

I am part of a group of female orthopedic surgeons (WOGO) who travel to third world countries to improve the lives of people by improving mobility through joint replacement.   We also believe it is important to teach doctors in those communities and to be role models for young women. Dikembe Mutombo, an NBA Hall of Fame basketball player, who is from Congo, asked our group to go to his hospital. Biamba Marie Mutombo Hospital is a 150 bed hospital with modern equipment including the only CT scanner in the country, an intensive care unit, and 3 operating rooms. Our group would be performing the first knee replacements done in that hospital, and possibly the first done in the country.  This was an incredibly challenging trip.  This is our story of what it was like to do knee replacements in Congo.

Travel and Logistics

It was a long plane ride.  Over 16 hours of travel.   We were met at the airport by police officers with machine guns who would be traveling with us everywhere we went.   The team was all assembled at the hotel. We are a large group with over 40 volunteers  including surgeons, scrub techs, nurses, anesthesiologists, internists, physical therapists, and a translator. Last month, a smaller team had traveled to Congo for the weekend to select patients for surgery.   We arrived Thursday evening, with the plan to start operating on Friday.   We planned to do  52 knee replacements in 4 days of surgery.  In March, 9000 lbs of orthopedic equipment and supplies had been sent by ship to the DRC.  We had been told the cargo was there and an advance team had arrived  a day early to unload and unpack the shipping container.

Challenges

There was only one problem.  The cargo was not at the hospital.   It was in the country, but we needed a signature, or maybe more than one, in order for it to be released from customs.   Mr. Mutombo spent Thursday and Friday trying to get those signatures.   Our team was waiting at the hospital to unload the cargo.  By 6pm on Friday, we were worried.  Supposedly the signatures had been obtained but a customs agent could not be found to escort the cargo.  An ultimatum was given.  If the cargo did not arrive by 7 am the next day we would not be able to do our surgeries.   We were about to leave the hospital when word came that the cargo was on its was on its way.  Mr. Mutombo had called the president of the country, and a customs agent had been found.

Teamwork

The shipping container arrived around 9.30 pm, along with Mr. Mutombo.  We were tired, hungry, jet-lagged, and excited.  Everyone pitched in to unload hundreds of boxes and more them to the operating rooms and the hospital floor.  Boxes were loaded onto stretchers and laundry carts.   It was truly a team effort.   Pizza arrived an hour later and was the best pizza we had ever tasted. But boxes still needed to be unpacked and the equipment organized. By midnight we were all on the bus for the ride to the hotel.   The  next day buses would leave at 6.30 am and we would finally be able to start doing knee replacements.

This story will be continued next month.

Top Three Things to Do Before Having Surgery

Posted on July 5, 2016.

by: Kathleen A. Hogan, MD

Everyone who has surgery worries about what can go wrong.   No surgery, no matter how minor, is without some risk.   However there are a few things that you can do before having surgery which may reduce the risk of complications.

Stop Smoking

Yes, smoking can result in lung cancer.   But there are more immediate risks for smokers having surgery.   Studies have shown significantly increased risks of heart attacks, strokes, pneumonia, blood clots, infection, and death after surgery in smokers.   Nicotine also impairs the body’s ability to heal surgical wounds, thereby increasing the risk of infection.  Fractures heal more slowly in smokers and there is a risk that joint replacement implants will not properly adhere to the bone in smokers.   It is recommended to stop smoking at least 6 weeks before your planned surgery.

Lose Weight

No one likes, or needs to be told to lose weight.  However, obesity may increase the risk of surgical complications such as heart attacks and urinary tract infections. The risk of infection after joint replacement rises exponentially in patients who are significantly overweight.   These risks are further increased in patients with high blood pressure, diabetes, or heart disease. How do you know if you are overweight? Calculate your body mass index by dividing your weight (kg) by height squared (cm). In New Hampshire, approximately 36% of adults are overweight (BMI>25) and 26% are obese (BMI>30). Weight loss is not easy, but may decrease your risk of surgical complications.

Visit a Dentist

According to the CDC, more than 20% of adults have untreated cavities.  Studies have shown that improving oral care preoperatively reduces the risk of pneumonia and mortality after cardiac surgery.  Infections around the teeth can spread bacteria into the blood stream and can cause severe infections around total joint replacements.  I ask my patients if they have untreated dental disease and postpone surgery until it is resolved.   Only 61% of adults visited the dentist within the past year.  Brush and floss daily and visit a dentist at least once each year.

Is it more difficult to stop smoking, lose weight, or get a root canal? None of these things are easy or fun to do.  However, they are three steps that should be considered before having elective surgery in order to decrease the risk of complications.  Discuss these issues with your doctor if you are planning on having joint replacement surgery.

36 hours in the Congo

Posted on June 2, 2016.

by Kathleen A. Hogan, MD

“Going up that river was like traveling back to the earliest beginnings of the world, when vegetation rioted on the earth and the big trees were kings.”
 Joseph Conrad – Heart of Darkness

Traveling to the Democratic Republic of Congo (DRC)

It takes approximately 19 hours, flying over 7000 miles to reach the Democratic Republic of Congo (DRC) from Boston.  It is not a trip that many people take for just a weekend. Indeed, the DRC is not a place frequented by American tourists.   But recently I found myself flying to the Congo for a quick 36 hour trip.  Why?  Together with a nurse, an internist, another orthopedic surgeon and a physician assistant, I was there to pre-screen patients for total knee replacements at the Biamba Marie Mutombo Hospital in Kinshasa.    

Why the DRC?

I am part of a group of female orthopedic surgeons (WOGO) who travel to third world countries to improve the lives of people by improving mobility through joint replacement.   We also believe it is important to teach doctors in those communities and to be role models for young women. On this trip, we are partnering with the Dikembe Mutombo Foundation (DMF).  Dikembe Mutombo, a former all-star professional basketball player, is from Kinshasa and has developed this foundation to improve the health, education, and quality of life of the people of the Congo. The hospital opened in 2007 and is named after his mother. Over 100,000 people have been treated since it opened.

About the DRC

The DRC is located in central Africa, on the equator. It is the third largest country in Africa, two thirds the size of Western Europe.  It has vast natural resources and its forests are home to endangered species of Mountain Gorillas and elephants. However, the recent history of the DRC has been one of war and unrest. A former colony of Belgium, the country gained independence in 1960.  After a political coup, the Congo became known as Zaire under its dictator Joseph Mobutu from 1965-1997. From 1998-2003 the country was at war and over 3 million people were killed.  Free elections were held in 2006 and the country became known as the DRC.

Income, Life Expectancy and Disease

Joint replacements are seldom performed in DRC. Those who can afford it travel to other countries such as South Africa or India for surgery. The average income in this country is approximately $600 per year, which ranks it as one of the poorest countries in the world. Life expectancy is only 45 years as 20% of children die before age 5.  Malaria and other tropical diseases are extremely common as is tuberuclosis, polio, and HIV/AIDS. Most of the people we met were in their 60’s but a few were in their 80’s. Most were surprisingly very healthy, with high blood pressure and diabetes being the most common medical problems.  

The Patients We Evaluated

In a day and a half, the five of us met with the team of doctors and nurses we will be working with during our trip. Everyone worked incredibly hard. In this short time, we evaluated almost 90 patients.  Many people that we saw had very severe arthritis.  Many patients had much more severe deformities then we typically see in the US. Everyone was extremely grateful. Some patients waited over 10 hours to see us that day in 90 degree heat.  When I apologized to my last patient of the day for her long wait, she said simply “when you are in pain you will wait.”  

The people of the Congo have endured much hardship and poverty due to wars and political corruption. Access to good medical care is extremely limited.  We hope that we can make a positive difference in the lives of the people we care for during our return trip to the DRC in July to perform knee replacement surgeries.  More information on our upcoming trip can be found at wogo.org.

Arthritis of the Thumb

Posted on May 23, 2016.

by: Jinsong Wang, MD, PhD

Your thumb accounts for about half of your hand function. Sometimes people don’t realize how important the thumb is until it doesn’t function properly anymore. The most common arthritis involving the thumb is thumb CMC joint arthritis. This is the joint where the thumb attaches to the hand. This joint is sometimes referred to as the basal joint of the thumb. There are several strong, thick ligaments keeping the joint stable. There are also nine muscles that provide dynamic stabilization of the CMC joint. They coordinate to put the thumb in position for optimal function.

What are the causes?

Degenerative arthritis develops over a period of several years. It can also be called osteoarthritis or degenerative arthrosis. The wear and tear of the joint comes with daily use. This leads to damage on the cartilage of the joint surface. The cartilage loss can result in bone on bone friction and arthritis. Women are more likely to develop thumb CMC arthritis than men.

What are the symptoms?

Pain is the most common symptom of thumb CMC arthritis. The most common complaints are pain with activities that involve gripping or pinching, swelling and tenderness at the base of the thumb, loss of strength, limited motion and deformity.

How to make the diagnosis?

Doctors will establish the diagnosis by taking your history, performing a clinical examination, and sometimes using x-rays.

What are the treatments?

Treatments can be divided into nonsurgical and surgical treatments.

Nonsurgical treatments:

  • Modification of activities which means reducing the activities that are causing symptoms.
  • Brace or splint may be prescribed to support the thumb which can be prefabricated or custom made
  • Hand therapy can sometimes help to decrease the swelling and pain of the joint.
  • Over the counter or prescription anti-inflammatory medication can be used to control the pain.
  • An injection of cortisone into the joint can temporarily reduce pain for a period of several weeks to several months.

Surgical treatment:

  • CMC joint fusion is designed to fuse two bones that make up the joint into one solid bone. It will create a pain free but motionless joint. It is usually considered for younger patients who use their hands for heavy work.
  • Artificial joint replacement with prosthesis is an option- These metal or plastic prostheses are available to replace the thumb CMC joint. However, long term results have not been widely successful.
  • Resection joint replacement- The purpose of the surgery is to remove the arthritic joint surfaces of the CMC joint and replace them with a cushion of material that will keep the bones separated. Traditional ligament reconstruction and tendon interposition (LRTI) procedures have been done for many decades. It has a good track record for pain relief of the joint. Newer procedures use alternative cushion materials instead of using patient’s own tendon.

What should I expect after the surgery?

It takes three to four months to recover from thumb CMC joint replacement. Your thumb and wrist will be placed in a thumb spica splint (a splint extending from thumb to forearm) for six weeks. After six weeks, the thumb will be placed in a removable short thumb spica splint. At that time you will start range of motion exercises and be treated by a hand therapist. There will be no restrictions on your hand three to four months from the time of surgery. However, hand strength will take longer to recover.

If you are experiencing any of the symptoms listed above, or you’d like to be seen for another hand issue, call 603.883.0091 to schedule an appointment with one of our fellowship-trained hand and upper extremity specialists!

How to Lose Weight When Your Joints Hurt

Posted on April 26, 2016.

by: Kathleen A. Hogan, MD

People who are obese (body mass index -BMI >30) have an almost seven times increase in the incidence of knee arthritis compared to those with a normal body mass index (BMI 18.5-25). Weight loss has been shown to reduce the pain associated with knee arthritis and improve function.  However, many of my patients with severe knee or hip arthritis tell me that they are unable to lose weight because they cannot exercise due to their arthritis pain. How can you lose weight when you cannot exercise?  

This article is meant to give you some suggestions and ideas on how to lose weight when your joints hurt too much to exercise. You should talk with your medical doctor before starting a weight loss program, and about specific dietary or physical limitations you may have.

Keep a Food Diary

My first suggestion is to keep a food diary. There are many free apps that you can download to your phone or computer which determine the caloric content of what you eat. For some people, just keeping track of calories can prevent over eating. Some patients tell me they do not eat very much but still gain weight.

Sometimes it is not how much you are eating but what you are eating.  For example, 200 calories can be a plate overflowing with broccoli or carrots, half a hamburger, or half a candy bar.  Which is going to fill you up the most? Unfortunately the candy bar tastes the best!  Keep in mind that 200 extra calories take approximately an hour of walking to burn off!

Use Calorie Information to Make Healthier Choices

Many restaurants now list calories which can help you make healthier choices. The cafeteria at Catholic Medical Center lists “better alternatives” to high calorie foods. For example, who would have guessed that Baked Potato chips have less calories and fat (130 cal, 2g fat) then French Fries (300 cal, 15 g fat)? A bagel with cream cheese has over 400 calories compared to only 170 calories in a slice of french toast. Small changes in food choices can sometimes make a large difference in the number of calories consumed throughout the day.

Be Active Throughout the Day

Being active throughout the day is also important. This increases the number of calories you burn.  If you are very sedentary, you will need to consume considerably less calories each day to avoid gaining weight compared to someone who is more active.

Many patients with arthritis complain that their joints feel stiff when they get up from sitting.  Your joints are made to move. Movement lubricates all joints, even those with arthritis. Just because your knees hurt too much to run on the treadmill does not mean that you cannot exercise.

Do Low Impact Exercise

Swimming, water aerobics, biking, and the elliptical trainer all put less impact on your joints then walking. Strength training builds muscle and burns calories. It also builds bone density. The stronger your muscles are, the better they support your joints which reduces pain from arthritis. If you have never lifted weights before, you may want to start off by working with a sports trainer or physical therapist to learn how to do it correctly.

Barre, pilates, and yoga classes can also improve your flexibility, strength, and balance in addition to burning calories.  Some gyms and senior centers offer classes specifically designed for people who have arthritis.    Exercising with other people can help you stay motivated.  Even thirty minutes a day of exercise can have a positive effect.

Don’t Give Up

Do not give up. Just because you had a cupcake and sat on the couch tonight watching television does not mean you cannot exercise or lose weight. Try not to be too hard on yourself and set realistic goals so that you will achieve them.  Arthritis may make weight loss more challenging, but nothing is impossible. The first step is always the most difficult.